婴儿巨大室间隔缺损并肺动脉高压的围术期处理

Enormous ventricular septal defect with pulmonary hypertension in infants during the peroperation time

目的总结婴儿巨大室间隔缺损（VSD）手术治疗及手术前后处理经验。方法1998年1月至2006年1月对152例婴儿巨大VSD在低温体外循环下行修补术，同时矫正合并畸形。结果术后低心排血量综合征死亡3例，急性肾功能衰竭死亡2例，灌注肺死亡2例，病死率4．61％。并发症发生率12．5％，共19例，其中Ⅲ度房室传导阻滞2例，术后经应用体外心脏起搏及微量泵静脉泵入异丙基肾上腺素8d，窦性心律恢复；术后残余分流3例，超声检查仅见1～2mm残余分流，未行特殊处理。呼吸机相关肺炎9例，经用体疗及抗生素治疗痊愈。全组患儿气管插管10～96h，平均（12±8）h。143例随访1～7年，发育状况明显好转。结论婴儿巨大VSD合并肺动脉高压以及反复肺炎、心衰内科治疗不能控制者均应及早手术治疗，并能取得满意疗效。同时，良好的心肌保护和完善的手术前后处理是降低病死率的关键。

Objective To summerize the experiences of operation and postoperative treatment of large ventricular septal detect （VSD） in infants. Methods One hundred and fifty two infants with large VSD underwent surgical repairment under hypothermie extracorporeal circulation from Januany 1998 to January 2006 . The other complicated malformations were rectified during the operation. Results Three patients died from low cardiac out - put with the hospital mortitity of 4.61%. The incidence of complications was 12.5%. One case had Ⅲ degree - AVB that recovered sinus rhythmia 8 days later through settled artifical cardiac pacing and pumped into perenaline ; three cases had a residual shunting that was only 1 or 2 millimetre estimated by color ultrasonic. The mechanical ventrilation time ranged from 10 to 96 hours [ mean（ 12 ± 8） h]. Follow - up visits of 143 cases from 1 to 7 years showed that their growth get bctter very much. Conclusion Large VSD repairment should be performed as early as possible for infants with pulmonary hypertension and repeated pulmonary infection or heart failure that is not easy to be corrected by physician. The out - come is satisful, meanwhile. It is important to enhance myocadical protection and do a perfect postoperative treatment in order to decrease the hospital mortality.